Medical Review Nurse Resume
Medical review nurses examine medical records and confirm whether the proposed treatments are covered under the insurance policy or not. They work with insurance companies and hospitals and determine the proposed treatment falls under the insurance coverage or not. With the insurance company, their job may involve traveling to various medical settings that have insurance contracts with the company. If they are employed by hospitals, they will work with medical professionals and insurance teams to provide treatments to patients in a way that should not create any problems in the claim procedures.
Whether you want to work for the insurance company or a hospital, you have to draft a resume in order to claim the job position. Take some help from this sample resume to apply.
Medical Review Nurse Resume Example
Norma A. Smith
2047 Irish Lane
Lancaster, WI 53813
Phone: 608-723-1531
Email: nasmith@anymail.com
Career Objective:
To work with “My Care Hospital” as a medical review nurse and ensure patients are provided necessary medical care and treatment according to their needs.
Summary of Skills:
- Excellent knowledge of insurance protocols used in medical treatments
- Familiarity with the medical claim procedures
- Skilled in reviewing medical records and proposed treatments
- Experienced in providing medical and nursing care to patients
- Excellent research and analytical skills
- Familiarity with the insurance claim procedures
- Ability to review proposed treatment and find cost-effective treatments
- Strong communication and organizational skills
Work Experience:
Medical Review Nurse
Miracle Hospital, Lancaster, WI
October 2012 - Present
- Review medical records and evaluate medical necessity of treatment
- Work with insurance teams and medical professionals to provided needed treatments to patients
- Determine patient needs, cost of the treatment and find better alternatives
- Ensure insurance protocols are following in patients' treatments
- Communicate with the insurance company and get approval for certain diagnosis and treatments
- Help patients in completing formalities at times of denial of claims
- Work with insurance companies and set standards and protocols
Medical Review Nurse
Live Well Medical Center, Lancaster, WI
February 2010 - September 2012
- Reviewed insurance claims and evaluated medical necessity
- Assisted physicians with clinical functions
- Identified and reported minor and major lapse in medical treatment to management
- Supported insurance team in handling claim denial cases
- Reviewed medical documents and relevant information following insurance protocols
- Attended conferences and meetings as required
- Complied with state and federal regulations and requirements
Education:
-
Bachelor's Degree in Nursing
St. Mary's Nursing College, Lancaster, WI
2009
Reference:
On request.